Survival improvement by systemic chemotherapy in adult patients with recurrent glioblastoma multiforme treated with two courses of radiotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1578-1578
Author(s):  
C. Nieder ◽  
A. L. Grosu ◽  
S. Astner ◽  
N. Andratschke ◽  
M. Molls
Keyword(s):  
Overall Survival ◽  
Glioblastoma Multiforme ◽  
Surgical Resection ◽  
Cumulative Dose ◽  
Systemic Chemotherapy ◽  
Local Treatment ◽  
Adult Patients ◽  
External Beam ◽  
Median Cumulative Dose ◽  
First Diagnosis

1578 Background: We evaluated the added value of systemic chemotherapy (CTx) in adult patients with recurrent supratentorial glioblastoma multiforme (GBM) selected to receive local re-treatment (administered as a 2nd course of radiotherapy, RTx). Methods: Retrospective comparison of two patient cohorts treated subsequently during different time periods. All patients had histologically confirmed recurrent GBM. Minimum recurrence-free interval was 4 months. The first cohort (n=26) had surgical resection and standard postoperative external beam RTx followed by a second course of external beam RTx for recurrence (median cumulative dose 102 Gy). None of these patients ever received CTx during the whole course of disease. The more recently treated cohort (after 1999) of 19 patients also had surgical resection and 2 courses of external beam RTx (median cumulative dose 90 Gy). After primary local treatment, 9 of these patients had adjuvant nitrosourea-based CTx. At recurrence, all 19 patients received temozolomide 150–200 mg/m2/day for five days every 4 weeks in addition to RTx. Results: The cohort without CTx had less favorable baseline characteristics, because of their significantly lower median KPS at recurrence (70 vs. 90%, p<0.01) and shorter interval between primary diagnosis and recurrence (12 vs. 16 months, p<0.05). However, these patients were non-significantly younger (median age 44 vs. 50 years, p>0.05). The percentage of patients with secondary GBM was similar (21 vs. 23%, p>0.5). Median survival from re-irradiation was significantly better in the RTx plus CTx group, 9 vs. 5 months (p<0.05). In multivariate analysis, prognosis was significantly improved by CTx. Importantly, there was also an advantage when overall survival from first diagnosis was evaluated, median 24 vs. 19 months (p<0.05). Conclusion: The current data suggest that re-irradiation plus temozolomide is better than re-irradiation alone. CTx led to a prolongation of overall survival from first diagnosis by 5 months. The most intensively treated, prognostically favourable de-novo GBM patients had surgical resection, 2 courses of RTx and 2 different systemic CTx regimens. [Table: see text]

scholarly journals Rationale and Clinical Implications of Fluorescein-Guided Supramarginal Resection in Newly Diagnosed High-Grade Glioma

2021 ◽  
Vol 11 ◽  
Author(s):  
Linda M. Wang ◽  
Matei A. Banu ◽  
Peter Canoll ◽  
Jeffrey N. Bruce
Keyword(s):  
Overall Survival ◽  
Surgical Resection ◽  
Local Treatment ◽  
Standard Of Care ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
Brain Parenchyma ◽  
Clinical Implications ◽  
Current Standard ◽  
Supramarginal Resection

Current standard of care for glioblastoma is surgical resection followed by temozolomide chemotherapy and radiation. Recent studies have demonstrated that &gt;95% extent of resection is associated with better outcomes, including prolonged progression-free and overall survival. The diffusely infiltrative pattern of growth in gliomas results in microscopic extension of tumor cells into surrounding brain parenchyma that makes complete resection unattainable. The historical goal of surgical management has therefore been maximal safe resection, traditionally guided by MRI and defined as removal of all contrast-enhancing tumor. Optimization of surgical resection has led to the concept of supramarginal resection, or removal beyond the contrast-enhancing region on MRI. This strategy of extending the cytoreductive goal targets a tumor region thought to be important in the recurrence or progression of disease as well as resistance to systemic and local treatment. This approach must be balanced against the risk of impacting eloquent regions of brain and causing permanent neurologic deficit, an important factor affecting overall survival. Over the years, fluorescent agents such as fluorescein sodium have been explored as a means of more reliably delineating the boundary between tumor core, tumor-infiltrated brain, and surrounding cortex. Here we examine the rationale behind extending resection into the infiltrative tumor margins, review the current literature surrounding the use of fluorescein in supramarginal resection of gliomas, discuss the experience of our own institution in utilizing fluorescein to maximize glioma extent of resection, and assess the clinical implications of this treatment strategy.

Intra-operative radiation therapy as salvage treatment option for recurrent glioblastoma multiforme.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2535-2535
Author(s):  
Nidal Salim ◽  
Alexey Krivoshapkin ◽  
Daria Zvereva ◽  
Alexey Gaytan ◽  
Orkhan Abdullaev ◽  
...  
Keyword(s):  
Overall Survival ◽  
Glioblastoma Multiforme ◽  
External Beam Radiotherapy ◽  
Adjuvant Radiation ◽  
External Beam ◽  
Cerebral Tumor ◽  
Electronic Brachytherapy ◽  
Local Progression ◽  
Microsurgical Resection ◽  
Recurrent Gbm

2535 Background: Glioblastoma multiforme (GBM) is an extremely aggressive cerebral tumor with poor prognosis. The majority of patients relapse after the initial surgery plus adjuvant radiation and chemotherapy. In case of recurrence there is no established standard therapy. The optimal techniques for salvage re-irradiation are unclear, so that procedure poses a challenge. In contrast to traditional external beam radiotherapy (EBRT) intra-operative radiotherapy (IORT) may improve patient’s outcome at the cost of minimal side effects and short treatment duration. Methods: A total of 30 patients were treated with recurrent GBM between August 2016 and June 2019. All patients underwent maximal safe resection; patients were divided into IORT and EBRT groups. 15 patients were included in each group with similar clinical characteristics. All patients in IORT group underwent maximal safe microsurgical resection with subsequent intraoperative balloon electronic brachytherapy (IBEB) and no further adjuvant treatment. IBEB was performed using Axxent electronic brachytherapy device (Xoft Electronic Brachytherapy (eBx) System, USA. Patients in EBRT group underwent same surgery followed by external beam radiotherapy. Contrast-enhanced brain MRI with perfusion was performed within 24 hours of surgery +/- brain PET-CT with 18-FDOPA and then every 3 months. Both groups were also assigned to subgroups (≤ 2.5cm3 and > 2.5cm3) based on post-operative contrast-enhancing volume (POCEV). Median overall survival (OS) since diagnosis and local progression-free survival (locPFS) following the second surgery were analyzed. Possible toxicities and prognostic factors were also evaluated. Results: Median OS was 27 months in IORT group and 21 months in EBRT group. The locPFS range between 3.5 to 39 months in IORT group and only 2 to 10 months in group with EBRT. Kaplan-Meier OS curves in patients with POCEV ≤ 2.5cm3 showed more favorable outcomes for patients in the IORT group (p < 0.05). In patients with POCEV > 2.5cm3 the median OS was 17 months in IORT group and 13.5 months in EBRT group. Conclusions: IORT of recurrent GBM is feasible and provides encouraging local progression-free and overall survival; no high-grade radiation induced toxicities occur and further studies to establish this method are mandatory. The toxicity profile of additional IBEB was manageable. Maximal safe microsurgical resection is the most important prognostic factor and could determine the effectiveness of post-surgical IBEB.

scholarly journals Stereotactic Radiotherapy for Oligometastasis

Cancers ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 133 ◽  
Author(s):  
Sotaro Otake ◽  
Taichiro Goto
Keyword(s):  
Overall Survival ◽  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Metastatic Cancer ◽  
Randomized Study ◽  
Local Treatment ◽  
High Dose ◽  
Oligometastatic Disease ◽  
Stereotactic Ablative Body Radiotherapy ◽  
Malignant State

Oligometastatic disease is defined as “a condition with a few metastases arising from tumors that have not acquired a potential for widespread metastases.” Its behavior suggests a transitional malignant state somewhere between localized and metastatic cancer. Treatment of oligometastatic disease is expected to achieve long-term local control and to improve survival. Historically, patients with oligometastases have often undergone surgical resection since it was anecdotally believed that surgical resection could result in progression-free or overall survival benefits. To date, no prospective randomized trials have demonstrated surgery-related survival benefits. Short courses of highly focused, extremely high-dose radiotherapies (e.g., stereotactic radiosurgery and stereotactic ablative body radiotherapy (SABR)) have frequently been used as alternatives to surgery for treatment of oligometastasis. A randomized study has demonstrated the overall survival benefits of stereotactic radiosurgery for solitary brain metastasis. Following the success of stereotactic radiosurgery, SABR has been widely accepted for treating extracranial metastases, considering its efficacy and minimum invasiveness. In this review, we discuss the history of and rationale for the local treatment of oligometastases and probe into the implementation of SABR for oligometastatic disease.

Efficacy and Safety of Once-Weekly Bortezomib Infusion in the Treatment of Relapsed/Refractory Multiple Myeloma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5141-5141 ◽  
Author(s):  
Hyun-Kyung Kim ◽  
Yeung-Chul Mun ◽  
Eun-Sun Yoo ◽  
Kyoung Eun Lee ◽  
Eunmi Nam ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cumulative Dose ◽  
Overall Response Rate ◽  
Response Rate ◽  
Drug Discontinuation ◽  
Line Treatment ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Grade 3 ◽  
Median Cumulative Dose

Abstract Abstract 5141 Incorporation of bortezomib in the treatment of multiple myeloma (MM) has significantly imporved patient outcome. Because peripheral neuropathy (PN) leading to dose modification and drug discontinuation seems to be dependent on dose and exposure of bortezomib, some schedules of botezomib therapy were reduced from twice-weekly to once-weekly infusion. We assessed the efficacy and safety of once-weekly bortezomib infusion in the treatment of relapsed/refractory MM. We compared the outcomes and safety of once- and twice-weekly bortezomib infusion as a second-line treatment for the patients of relapsed/refractory MM in our hospital between 2005 and 2010, retrospectively. Twenty-nine patients were enrolled including 12 patients who received once-weekly bortezomib infusion on day 1, 8, 15 and 22 of the cycles and 19 patients who received twice-weekly bortezomib infusion on day 1, 4, 8 and 11 of the cycles as a second-line treatment. Dexamethasone alone (n=18), melpahalan with prednisolone (n=4), and thalidomide with dexamethasone (n=7) were administered combined with bortezomib. Median cumulative dose of bortezomib were 32.4mg/m2 and 18.4mg/m2 in the once- and twice-weekly group, retrospectively (p=0.019). There were no significant difference in overall response rate (66.7% in once-weekly vs 47.1% in twice-weekly, p=0.451) and time-to-progression (median 17.2 months in once-weekly vs 7.1 months in twice-weekly, p=0.381). There was a significant difference in the median time-to-onset of grade 2 to 4 PN (4.5 months in once-weekly vs 2.0 months in twice-weekly, p=0.017). The incidence of grade 2–4 PN (50.0% vs 47.1%) and median cumulative dose to onset of grade 2–4 PN (17.9mg/m2 vs 15.3mg/m2) were not different. The incidence of any grade 3/4 toxicity except PN was similar (25.0% vs 41.2%, p=0.449). Progression-free survival in once-weekly bortezomib group was slightly longer than that in twice-weekly bortezomib (median 34.8 months vs median 22.8 months, p=0.074). Overall survival was similar (median 35.2 months vs median 25.1 months, p=0.118), while the overall survival of elderly patients (60 years or above) in once-weekly bortezomib group was slightly longer than that in twice-weekly bortezomib group by Kaplan-Meier analysis (median 38.1 months vs median 20.1 months, p=0.085). Our data suggest that the onset time of PN was delayed in once-weekly regimen and there was no significant difference overall response, rate of PN, cumulative dose to onset of PN, grade 3/4 toxicity and overall survival between both groups. Because of the larger cumulative dose and the lower rate of dose modification or drug discontinuation due to good tolerability in once-weekly bortezomib than twice-weekly bortezomib, once-weekly bortezomib infusion could be a potential therapeutic approach for patient with MM as a scond-line therapy. Disclosures: No relevant conflicts of interest to declare.

Surgery Versus Radiation Treatment for High-Grade Neuroendocrine Cancer of Uterine Cervix: A Surveillance Epidemiology and End Results Database Analysis

2018 ◽  
Vol 28 (1) ◽  
pp. 188-193 ◽  
Author(s):  
Wei-Hsien Hou ◽  
Tim E. Schultheiss ◽  
Jeffrey Y. Wong ◽  
Mark T. Wakabayashi ◽  
Yi-Jen Chen
Keyword(s):  
Overall Survival ◽  
Radiation Treatment ◽  
Radical Surgery ◽  
Local Treatment ◽  
International Federation ◽  
External Beam Radiation ◽  
External Beam ◽  
High Grade ◽  
Beam Radiation ◽  
Gynecology And Obstetrics

ObjectivesThe objective of this study was to assess treatment and other factors impacting survival in cervical high-grade neuroendocrine carcinoma (HGNEC).Methods/MaterialsWe identified patients with cervical HGNECs diagnosed during 1988 to 2012 in the Surveillance Epidemiology and End Results database. We determined overall survival by International Federation of Gynecology and Obstetrics stages and by local treatment modalities, that is, radical surgery versus external beam radiation treatment (EBRT) plus brachytherapy using Kaplan-Meier analysis with log-rank test. We also determined factors of age, stage, and treatment modality impacting survival using proportional hazard analysis.ResultsWe identified 832 cases of cervical HGNECs in the database. After excluding cases with incomplete stage data, the International Federation of Gynecology and Obstetrics stages I to IV distributions were 196 (28.0%), 69 (9.9%), 175 (25.0%), and 260 patients (37.1%), respectively. Radical surgery and primary radiotherapy yielded similar 5-year overall survival for stages I (61% vs 53%,P= 0.27), II (48% vs 28%,P= 0.308), and III (33% vs 28%,P= 0.408) patients. External beam radiation treatment plus brachytherapy did not yield superior survival than EBRT alone in stage I (48% vs 49%,P= 0.799), II (37% vs 20%,P= 0.112), or III (25% vs 32%,P= 0.636) patients. Age (P= 0.004) and stage (stage II: hazard ratio [HR], 1.78,P= 0.013; stage III: HR, 2.42;P< 0.001) were independent factors impacting survival but not local treatment modality (EBRT: HR, 1.30,P= 0.17; EBRT plus brachytherapy: HR, 1.16;P= 0.417).ConclusionsPatients with cervical HGNECs had poor prognosis. Primary treatment by radical surgery or external beam radiotherapy with or without brachytherapy yielded equally poor survival.

Microsurgical resection of a glioblastoma multiforme of the medulla oblongata with intraoperative subcortical stimulation and mapping

2019 ◽  
Vol 1 (2) ◽  
pp. V1
Author(s):  
Sima Sayyahmelli ◽  
Jian Ruan ◽  
Bryan Wheeler ◽  
Mustafa K. Başkaya
Keyword(s):  
Glioblastoma Multiforme ◽  
Surgical Resection ◽  
Medulla Oblongata ◽  
Cranial Nerves ◽  
The Body ◽  
Fine Motor ◽  
Surgical Video ◽  
Inferior Aspect ◽  
Hyperintense Signal ◽  
Microsurgical Resection

Primary glioblastoma multiforme tumors of the medulla oblongata are rare, especially in the adult population. Perhaps due to this rarity, we are not aware of any previous reports addressing the resection of these tumors or their clinical outcomes.In this surgical video, we present a 43-year-old man with a 1-month history of left-sided paresthesia. The paresthesia initiated in the left hand, along with weakness and reduced fine motor control, and then spread to the entire left side of the body. He had recent weight loss, imbalance, difficulty in swallowing, and hoarseness in his voice. He also had a diminished gag reflex, and significant atrophy of the right side of the tongue with an accompanying deviation of the uvula and fasciculations of the tongue. MRI showed an infiltrative expansile mass within the medulla with peripheral enhancement and central necrosis. In T2/FLAIR sequences, a hyperintense signal extended superiorly into the left inferior aspect of the pons and left inferior cerebellar peduncle and inferiorly into the upper cervical cord.The decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy for surgical resection of this infiltrative expansile intrinsic mass in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials and monitoring of lower cranial nerves IX, X, XI, and XII. A gross-total resection of the enhancing portion of the tumor was performed, along with a subtotal resection of the nonenhancing portion. The surgery and postoperative course were uneventful. Histopathology revealed a grade IV astrocytoma. The patient received radiation therapy.In this surgical video, we demonstrate important steps for the microsurgical resection of this challenging glioblastoma multiforme of the medulla oblongata.The video can be found here: https://youtu.be/QHbOVxdxbeU.

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